Search

Background One quarter to one third of patients eligible for systemic thrombolysis are on antiplatelet therapy at presentation. In this study, we aimed to assess the safety and efficacy of intravenous thrombolysis in stroke patients on prescribed antiplatelet therapy in the WAKE-UP trial. Methods WAKE-UP was a multicenter, randomized, double-blind, placebo-controlled clinical trial to study the efficacy and safety of MRI-guided intravenous thrombolysis with alteplase in patients with an acute stroke of unknown onset time. The medication history of all patients randomized in the WAKE-UP trial was documented. The primary safety outcome was any sign of hemorrhagic transformation on follow-up MRI. The primary efficacy outcome was favorable functional outcome defined by a score of 0–1 on the modified Rankin scale at 90 days after stroke, adjusted for age and baseline stroke severity. Logistic regression models were fitted to study the association of prior antiplatelet treatment with outcome and treatment effect of intravenous alteplase. Results Of 503 randomized patients, 164 (32.6%) were on antiplatelet treatment. Patients on antiplatelet treatment were older (70.3 vs. 62.8 years, p p = 0.014), but there was no interaction of prior antiplatelet treatment with intravenous alteplase concerning favorable outcome (p = 0.355). Intravenous alteplase was associated with higher rates of favorable outcome in patients on prior antiplatelet treatment with an adjusted odds ratio of 2.106 (95% CI 1.047–4.236). Conclusions Treatment benefit of intravenous alteplase and rates of post-treatment hemorrhagic transformation were not modified by prior antiplatelet intake among MRI-selected patients with unknown onset stroke. Worse functional outcome in patients on antiplatelets may result from a higher load of cardiovascular co-morbidities in these patients.

Additional file 1: Supplementary Material. Supplementary Methods. Supplementary Results. Supplementary Table 1. Levetiracetam plasma level. Supplementary Table 2. Side effects related to study drug levetiracetam. Supplementary Table 3. Results of the post-hoc analysis for the mean differences between Pre-Op and Baseline timepoints for NeuroCogFX scores. Supplementary Table 4. Results of the post-hoc analysis for the mean differences between Follow-Up and Baseline timepoints for NeuroCogFX scores. Supplementary Table 5. Estimated marginal means and post-hoc analysis for QOLIE31 subtest scores and overall score for all timepoints from the linear mixed model. Supplementary Table 6. Estimated marginal means for NeuroCog FX subtest-, domain-, performance- and Total scores for all timepoints, subdivided by main effects “time” and “neurosurgical procedure”. Supplementary Table 7. Estimated marginal means for NeuroCog FXsubtest scores, domain scores, performance scores and Total score for all timepoints, subdivided by maineffects (time, hemisphere) and interaction effect (time*hemisphere). Supplementary Figure1. Constitution of different scores of neuropsychological test battery NeuroCog-FX. Supplementary Figure 2. Levetiracetam plasma level and occurred seizures. Levetiracetam levels were measured one day before surgery (Pre-Op timepoint, two days after onset) and three days after surgery (Post-Op timepoint, six days after onset).The starting dose of levetiracetam was 2x500 mg on the first day, was escalated to 2 x 1000 mg on the second day and was maintained at this dose for overall nine days. Two patients each, who had a seizure three days post-surgery, are marked with blackpoints. Supplementary Figure 3. Severity of hematotoxicity markers in relative percentage. Values were measured one week after surgery. Grading according to National Cancer Institute – Common Terminology Criteria of Adverse Events (CTCAE) v5.0 (Grade 0 = within the normal range, Grade 1 = mild, Grade 2 = moderate, Grade 3 = severe, Grade 4 = life threatening). n = 43 in hemoglobin, thrombocytes and leukocytes; n = 39 in lymphocytes. Hemoglobin(g/dL): M, 12.24; SD, 1.43; range, 4.80-50. Thrombocytes(g/L): M, 221.5; SD, 86.71; range, 51-427. Leukocytes(g/L): M, 11.32; SD, 3.66; range, 3.5-20.7. Lymphocytes(g/L): M, 1.8; SD, 1.32; range, 0.3-7.92. Supplementary Figure 4. Frequency of patients reporting side effects related to study drug Levetiracetam in absolute percentage across four time points. If a patient reported an adverse reaction more than once and the CTCAE grade differed, the higher severity grade was selected. None of the patients reported side effects regarding abdominal pain, concentration impairment, amnestic aphasia, aggression, anxiety, nightmare, or tinnitus.

Objective: Corticosteroid treatment (CST) prior to biopsy may hinder histopathological diagnosis in primary central nervous system lymphoma (PCNSL). Therefore, preoperative CST in patients with suspected PCNSL should be strictly avoided if clinically possible. The aim of this study was to analyze the[for full text, please go to the a.m. URL], 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Knowledge about the topological and structural heterogeneity of the microvasculature is important for diagnosis and monitoring of glioma. A vessel caliber and type-dependent temporal shift in the magnetic resonance imaging signal forms the basis for vascular architecture mapping. This study introduced a clinically feasible approach for assessment of vascular pathologies in gliomas using vascular architecture mapping. Sixty consecutive patients with known or suspected gliomas were examined using vascular architecture mapping as part of the routine magnetic resonance imaging protocol. Maps of microvessel radius and density, which adapted to the vasculature-dependent temporal shift phenomenon, were calculated using a costume-made software tool. Microvessel radius and density were moderately to severely elevated in a heterogeneous, inversely correlated pattern within high-grade gliomas. Additionally, three new imaging biomarkers were introduced: Microvessel type indicator allowing differentiation between supplying arterial and draining venous microvasculature in high-grade gliomas. Vascular-induced bolus peak time shift may presumably be sensitive for early neovascularization in the infiltration zone. Surprisingly, curvature showed significant changes in peritumoral vasogenic edema which correlated with neovascularization in the tumor core of high-grade gliomas. These new magnetic resonance imaging biomarkers give insights into complexity and heterogeneity of vascular changes in glioma; however, histological validations in more well-defined patient populations are required.

Background and Purpose In patients already suffering from cancer, the additional occurrence of stroke can aggravate the burden of the disease. The purpose of this study was to compare risk factors for haemorrhagic and ischemic strokes in cancer and non-cancer patients. Methods A retrospective analysis, including 1,274 stroke patients admitted to a stroke unit, was conducted from 2004 to 2007. Classical risk factors for stroke and clinical outcome measures were compared between cancer and non-cancer patients. Results Twelve percent of stroke patients had an additional diagnosis of cancer. In the non-cancer population, 84% had ischemic and 16% had haemorrhagic strokes. In cancer patients, 86% had ischemic and 14% had haemorrhagic strokes. Vascular risk factors in cancer patients, including hypertension, atrial fibrillation, coronary vessel disease, smoking, hypercholesterolemia and diabetes mellitus, showed no difference compared to the non-cancer population. Only thrombotic events occurred more often in the cancer cohort. The most frequent cancer types were urogenital, breast and gastrointestinal. Regarding clinical outcome, cancer patients had an inferior neurological condition at discharge and a trend towards a longer stay in the stroke unit. Conclusions The frequency of ischemic and haemorrhagic stroke in tumour patients is similar to that in the non-cancer population. Cerebrovascular risk factors do not significantly vary between cancer and non-cancer patients. The higher frequency of thrombotic events in cancer patients may reflect a coagulation disorder, commonly found in patients with malignancy. Clinical outcome in cancer patients may be worsened by the pre-existent co-morbidity.